CONIUM is very useful medicine in malignant conditions of the stomach-either chronic ulcers that have become malignant or, more commonly, malignant growths round about the pylorus, usually with secondary deposits in the liver.
Many of the patients who ought to have Conium are given one of the sodium salts instead, the reason being that they have a definite dislike of people, want to be left alone and quiet, and have a definite craving for salt. But there are distinct differences in the mentality of Conium and of sodium patients. Conium patients do not want to be disturbed, but they dislike being entirely alone. They are depressed, but it is a very quiet, gentle melancholy in Conium, not the acute mental depression of the sodium patients. And there is very often a strange superstitiousness in Conium which is not usually associated with sodium cases.
Naturally, where you are dealing with a thing like an abdominal carcinoma, the patient is weak, tired out, and any mental effort is a great strain. One thing that helps you to your diagnosis of Conium is that this weakness is accompanied by definite tremulousness. It is also accompanied by very marked vertigo, particularly on any sudden movement: the patient, who has been sitting quietly, suddenly gets up from his chair, and becomes giddy; or he turns suddenly in bed and immediately everything begins to swing round.
As regards the appetite, there may be hunger-sometimes almost a craving for food-or there may be complete loss of appetite. A point to remember is their definite craving for salt. And not infrequently there is a marked aversion from bread in any form.
There are one or two interesting points in connection with the stomach symptoms. In Conium you frequently get a history that on swallowing food the patient feels as if i is stuck in his throat. Well, you get much the same condition in Natrum mur.- the ordinary Natrum mur. spasm-but, in Conium, the patient feels as if something rose up from the stomach and blocked the food that was coming down : Natrum mur. cases feel as if the oesophagus closed on the food and prevented it passing further. Then, apart from eating, Conium patients are apt to get the same sort of sensation of something rising up into the throat, and it often produces a quite irritating cough.
These patients commonly complain of acute heartburn and violent, stabbing pains, feeling exactly as if a knife were sticking into the right side of the upper abdomen, passing across to the left side and producing intense nausea. They frequently vomit and the material is always very stringy in character and difficult to get up. It may consist of stringy mucus, bile or coffee-ground material.
Another complaint of Conium patients is that, some little time after eating, they get a feeling as if the contents of the stomach were being pushed out through a narrowed pylorus. They tell you that they can often feel a definite lump rising up about the pyloric area as the food attempts to force its way through. And where these patients are suffering from a pyloric carcinoma you can feel the tumour.
In these cases you get early involvement of the liver, which is enlarged and irregular. Often they complain of very sharp, tearing, stitching pains in the liver. Associated with the early dissemination into the liver there will almost certainly be enlarged abdominal glands as well, very often hard lumps in the abdomen, and the whole abdomen very sensitive.
The patient often complaints that, apart from these hard lumps, there are areas in the abdomen which seem to come up in hard knots, as if there were intestinal spasm. But, rather than the spasmodic colic you associate with some of the other drugs, in these Conium patients you get acute cutting pains. Most of the gastric pains come on about a couple of hours after a meal, and they are all of this forcing character.
Many of these patients suffer from alternate attacks of diarrhoea and constipation. Whether they are constipated or have diarrhoea they are mostly very exhausted after the bowels have acted; they feel very shaky and almost faint.
With their abdominal carcinomas, these patients frequently have disturbances of the bladder, usually a partial paralysis in which the urine stops and starts and they have difficulty in completely emptying the bladder.
There is one other point which is sometimes a help. In addition to the cough which is associated with their gastric discomfort, Conium patients often complain bitterly of a very dry spot in the larynx, which they cannot moisten and which sets up a constant, irritating cough.